Provider Demographics
NPI:1669508917
Name:HEALTH ONE MEDICAL CENTER, EASTPOINTE LLC
Entity Type:Organization
Organization Name:HEALTH ONE MEDICAL CENTER, EASTPOINTE LLC
Other - Org Name:EASTPOINTE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-776-4185
Mailing Address - Street 1:21501 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3213
Mailing Address - Country:US
Mailing Address - Phone:586-776-4185
Mailing Address - Fax:586-776-5132
Practice Address - Street 1:21501 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3213
Practice Address - Country:US
Practice Address - Phone:586-776-4185
Practice Address - Fax:586-776-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065258208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4546847Medicaid